Pharmacological Aspects of Nursing Care 8Th Ed By Broyles Reiss Evans - Test Bank

Pharmacological Aspects of Nursing Care 8Th Ed By Broyles Reiss Evans – Test Bank

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CHAPTER 5: DRUG THERAPY FOR PEDIATRIC CLIENTS

TRUE/FALSE

1.The child’s developmental stage and the type of medication are important factors to consider in administering oral medications.

ANS: T PTS: 1 REF: p. 115, Safe Nursing Practice 5-1 | p. 117

OBJ: Cognitive Level: Comprehension

2.Parents should be asked to help restrain their child when the child receives an IM injection.

ANS: F

Feedback
Correct Parents should not be asked to help restrain their child when the child receives an IM injection.
Incorrect

PTS: 1 REF: p. 120 OBJ: Cognitive Level: Knowledge

3.Painful procedures should be performed in a child’s room, since this is a safe place for the child.

ANS: F

Feedback
Correct Painful procedures should not be performed in the child’s room, because the personal room should be maintained as a safe place for the child.
Incorrect

PTS: 1 REF: p. 120 OBJ: Cognitive Level: Knowledge

4.Children generally have short attention spans. When teaching children, the nurse should plan on approximately five minutes per developmental year for each teaching session.

ANS:TPTS:1REF:p. 120, Box 5-3

OBJ: Cognitive Level: Comprehension

5.When using a soluset for administering IV medication to children, the nurse should allow no more than 100 mL of solution in the administration chamber.

ANS: T PTS: 1 REF: p. 122 OBJ: Cognitive Level: Knowledge

MULTIPLE CHOICE

1.Which of the following is true of pediatric clients?

a. At birth, stomach acidity is very high.
b. Infants tend to have a small proportion of water in their bodies compared to adults.
c. Drug penetration through infant skin is more rapid than in older children.
d. Greater protein binding of drugs is observed in pediatric clients than in adults.

ANS: C

Feedback
A Incorrect: Gastric acidity is reduced.
B Incorrect: Infants have a much larger percentage of body water compared to adults.
C Correct: Infant skin is thinner, allowing for more rapid drug penetration than in older children.
D Incorrect: Protein binding in children is less than in adults, because of the child’s immature liver.

PTS: 1 REF: p. 122 OBJ: Cognitive Level: Knowledge

2.A history of maternal drug use is most closely related to a neonate’s ability to:

a. absorb drugs from the gastrointestinal tract.
b. excrete drugs by the kidney.
c. metabolize drugs in the liver.
d. bind drugs onto plasma proteins.

ANS: C

Feedback
A Incorrect: Maternal drug use does not affect drug absorption.
B Incorrect: Maternal drug use does not affect drug excretion.
C Correct: Maternal drug use can impact the child’s drug metabolism.
D Incorrect: Maternal drug use does not affect distribution.

PTS: 1 REF: p. 114 OBJ: Cognitive Level: Comprehension

3.Pediatric drug dosages are usually best calculated on the basis of the child’s:

a. body surface area. c. height or length.
b. age. d. weight.

ANS: D

Feedback
A Incorrect: Some drugs, such as antineoplastics, are calculated using BSA (body surface area), but most medication dosages for children are based on kg of body weight.
B Incorrect: Pediatric dosage calculations based on age alone generally are not accurate.
C Incorrect: Dosage calculations are not based on height.
D Correct: Most pediatric dosages are based on kg of body weight.

PTS: 1 REF: p. 115 OBJ: Cognitive Level: Knowledge

4.When administering a bitter medication to a child, the nurse or parent should:

a. refrain from telling the child that the medication is bitter.
b. tell the child that the medication tastes good.
c. encourage the child to put ice in the mouth for a few minutes before taking the medication.
d. mix the medication into the child’s milk at breakfast.

ANS: C

Feedback
A Incorrect: The nurse should be honest but firm with the child.
B Incorrect: The nurse should be honest but firm with the child.
C Correct: Ice in the mouth may decrease taste sensation when a bitter medication is being given.
D Incorrect: Medication should not be mixed in with essential foods, as the child may later avoid these foods.

PTS: 1 REF: p. 119 OBJ: Cognitive Level: Application

5.Brittany is a two-month-old receiving oral medications so the nurse should: plan to:

a. administer her medications before meals.
b. administer her medications rapidly, before she begins crying.
c. ask the health care provider to change the route to parenteral.
d. have the parents administer Brittany’s medication.

ANS: A

Feedback
A Correct: Oral medications should be administered when birth to three-month-olds are hungry to better ensure complete consumption of medications.
B Incorrect: Oral medications should be administered slowly and in as a small a volume as possible.
C Incorrect: The oral route is the most common and least traumatic for a young infant.
D Incorrect: Parents can be taught by the nurse to administer Brittany’s medication, if these are medications Brittany will be taking at home.

PTS: 1 REF: p. 118 OBJ: Cognitive Level: Application

6.When administering eardrops to children under three years, the nurse

a. pulls the pinna back and down. c. does not touch the pinna.
b. pulls the pinna up and back. d. holds the pinna flat against the skull.

ANS: A

Feedback
A Correct: This opens the ear canal in a young child.
B Incorrect: This is used for older children and adults.
C Incorrect: Pulling the pinna back and down opens the ear canal of a young child.
D Incorrect: Pulling the pinna back and down opens the ear canal of a young child.

PTS:1REF:p. 63, Figure 2-18A

OBJ: Cognitive Level: Application

7.The nurse is preparing to administer an intramuscular injection for an infant. To maintain the infant’s safety the nurse will perform the injection in which preferred site:

a. deltoid. c. dorsogluteal.
b. ventrogluteal. d. vastus lateralis.

ANS: D

Feedback
A Incorrect: This muscle is underdeveloped in young children.
B Incorrect: Although the ventrogluteal site can be used, it is not the preferred site.
C Incorrect: The posterior gluteal site is not used in children under three years of age.
D Correct: This is the preferred site for an IM injection in an infant.

PTS:1REF:p. 121, Figure 5-2

OBJ: Cognitive Level: Application

8.A mother asked the nurse about administering Ipecac syrup in the event of an accidental poisoning of one of her children: The nurse’s best response would be:

a. “Ipecac is a long-standing treatment and is still used as a standard.”
b. “You should not administer Ipecac; the staff in the ED will do that when the child reaches the hospital.”
c. “Adding flavoring to the Ipecac syrup will make it taste better to the child.”
d. “Both poison control centers and the American Academy of Pediatrics do not endorse the use of Ipecac syrup.”

ANS: D

Feedback
A Incorrect: Poison control centers and the American Academy of Pediatrics no longer endorse the use of Ipecac syrup.
B Incorrect: Poison control centers and the American Academy of Pediatrics no longer endorse the use of Ipecac syrup including by professionals.
C Incorrect: Poison control centers and the American Academy of Pediatrics no longer endorse the use of Ipecac syrup.
D Correct: After reviewing recent research both agencies withdrew their endorsement of the use of Ipecac syrup.

PTS: 1 REF: p. 125 OBJ: Cognitive Level: Application

9.When comparing the plasma protein binding ability of a pediatric client to an adult, the nurse understands this process occurs in children to:

a. a greater degree.
b. a lesser degree.
c. the same degree.
d. the same degree, but more slowly than in adults.

ANS: B

Feedback
A Incorrect: It occurs to a lesser degree than in adults, because of the reduced production of protein in children.
B Correct: It occurs to a lesser degree than in adults, because of the reduced production of protein in children.
C Incorrect: It occurs to a lesser degree.
D Incorrect: It occurs to a lesser degree.

PTS: 1 REF: p. 114 OBJ: Cognitive Level: Comprehension

10.The central nervous system of a child does not fully mature until approximately:

a. 4 weeks of age. c. 8 months of age.
b. 2 months of age. d. 14 months of age.

ANS: C

Feedback
A Incorrect: This is too early.
B Incorrect: This is too early.
C Correct: This occurs at approximately 8 months of age.
D Incorrect: This is much later that maturation of the CNS usually occurs.

PTS: 1 REF: p. 115 OBJ: Cognitive Level: Knowledge

11.When administering a rectal suppository to a two-year-old child, the nurse:

a. uses his or her little finger to administer the medication.
b. asks the mother if she would prefer administering the medication.
c. uses his or her index finger to administer the medication.
d. applies a local anesthetic to the anus before administering the medication.

ANS: A

Feedback
A Correct: Because the child is two years old, the little finger, rather than the index finger, is used to administer rectal suppositories.
B Incorrect: This is not appropriate, unless the mother has had experience with administering rectal suppositories to her child.
C Incorrect: In children under three years of age, the little finger, rather than the index finger, is used to administer rectal suppositories. 
D Incorrect: This is not appropriate.

PTS:1REF:p. 124, Box 5-4

OBJ: Cognitive Level: Application

12.The nurse is preparing to administer liquid medication to a nine-year-old child understanding that the best method would be:

a. using a syringe without a needle and squirting the medication slowly along the inside of the cheek.
b. using a dropper for the small amount of medication usually administered to a nine yo.
c. allowing the child to choose between a syringe without a needle and a medicine cup for drinking the medication.
d. asking the parents to restrain the child while using a syringe to administer the medication.

ANS: C

Feedback
A Incorrect: This is the technique used for an infant.
B Incorrect: A nine-year-old would receive a larger volume than a dropper would hold.
C Correct: At this age, allowing the child choices will increase cooperation in taking the medication.
D Incorrect: A nine-year-old should not need to be restrained and the nurse should never ask parents to restrain their child.

PTS: 1 REF: p. 119 OBJ: Cognitive Level: Application

13.A young child is to receive an IV antibiotic packaged in 50 mL of 5% dextrose and water over 30 minutes; the nurse would do which of the following:

a. use volumetric IV pump for administration.
b. use gravity drip for administration.
c. administer the medication via IV bolus.
d. delegate the activity to a nursing assistant.

ANS: A

Feedback
A Correct: Because of the volume and time of administration, it is not appropriate for IV bolus, so it should be administered using a volumetric IV pump.
B Incorrect: Gravity drip is not appropriate when administering IV medications to children.
C Incorrect: Because of the volume and time of administration, it is not appropriate for IV bolus.
D Incorrect: IV medication administration is out of the scope of practice of a nursing assistant.

PTS: 1 REF: p. 122 OBJ: Cognitive Level: Application

14.When planning parenteral medication, the nurse considers that beginning at which age can children receiving parenteral medication be permitted to handle a syringe without a needle?

a. 18 months c. 2 1/2 to 3 1/2 years
b. 2 years d. 5 to 6 years

ANS: C

Feedback
A Incorrect: This is too young.
B Incorrect: This is too young.
C Correct: Children at this age cooperate more if able to handle the equipment and this age group would be less likely to put the equipment in their mouth.
D Incorrect: Although this age group also can handle the syringe without a needle, it is not the beginning age group.

PTS:1REF:p. 119, Table 5-2

OBJ: Cognitive Level: Comprehension

15.When choosing a site for an IM injection in a young child, the nurse understands that the deltoid injection site is rarely used because:

a. this muscle is not fully developed until adolescence.
b. it is more difficult to restrain the child when using the deltoid site.
c. the child may become more upset when watching the nurse use this site.
d. all of these factors are rationales for not using this site.

ANS: A

Feedback
A Correct: The deltoid muscle is not fully developed until adolescence, so it is not an appropriate site for young children.
B Incorrect: This is not an appropriate rationale.
C Incorrect: This is not an appropriate rationale.
D Incorrect: b and c are incorrect, so this answer also is incorrect.

PTS: 1 REF: p. 121 OBJ: Cognitive Level: Comprehension

16.The proper needle length for a subcutaneous injection in infants and thin children is:

a. 3/8 to 1/2 inch. c. 5/8 to 1 inch.
b. 1/2 to 5/8 inch. d. 1 to 1 1/2 inches.

ANS: A

Feedback
A Correct: Needles any longer will reach the muscular layer of tissue.
B Incorrect: This needle is too long for infants and thin young children.
C Incorrect: This needle is too long for infants and thin young children.
D Incorrect: This needle is too long for infants and thin young children.

PTS: 1 REF: p. 121 OBJ: Cognitive Level: Knowledge

17.The nurse is preparing to give a three-year-old client the first dose of a prescribed antibiotic. Knowing the client may resist taking the medication, the client’s parents suggest the nurse tell her it is candy. What is the best response by the nurse?

a. “Children should not be told medicine is candy, because when they taste it they know it is not candy.”
b. “Telling children that medicine is candy is a dangerous practice. If the child finds the medicine, the child may attempt to eat it like candy.”
c. “Thanks, that approach may work for Mary.”
d. “Children should not be told medicine is candy, because when they taste it they may spit it out.”

ANS: B

Feedback
A Incorrect: This is not the rationale for not telling children medication is candy.
B Correct: This is the appropriate rationale to provide for parent teaching.
C Incorrect: This is not the rationale for not telling children medication is candy.
D Incorrect: This is not the rationale for not telling children medication is candy.

PTS:1REF:p. 117, Box 5-2

OBJ: Cognitive Level: Application

18.A six-month-old is going home from the hospital after being treated for pneumonia. Which statement made by the mother indicates a need for more teaching by the nurse? 

a. “ I should request childproof medication containers for medications stored in the home.”
b. “I should keep all medications out of reach of children and in a locked cabinet.”
c. “I can put the medication in the formula to help ensure that my baby takes it.”
d. “All of the medications are oral and I have oral administration syringes.”

ANS: C

Feedback
A Incorrect: This is an appropriate response by the mother.
B Incorrect: This is an appropriate response by the mother.
C Correct: Medication should not be placed in infant formula, because the child may not consume all of the formula and the medication will change the taste of the primary food, resulting in the risk that the infant may refuse to drink formula.
D Incorrect: This is an appropriate response by the mother.

PTS: 1 REF: p. 126 OBJ: Cognitive Level: Evaluation

19.The nurse is preparing to administer oral medication to an 11-month-old infant who drinks formula from a cup. The nurse decides to use which of the following for medication administration to this child?

a. a dropper c. medicine cup
b. a nipple d. infant restraint

ANS: C

Feedback
A Incorrect: This infant drinks from a cup, so a dropper would not be the best choice.
B Incorrect: This infant drinks from a cup, so a nipple would not be the best choice.
C Correct: This infant drinks from a cup, so a medicine cup would be appropriate.
D Incorrect: Infant restraint would not be the first choice for the nurse.

PTS:1REF:p. 118, Table 5-2

OBJ: Cognitive Level: Comprehension

20.Which of the following routes of medication administration demonstrates the least variability in drug response for pediatric clients of different ages?

a. oral c. intravenous
b. topical d. intramuscular

ANS: C

Feedback
A Incorrect: Children of different ages vary in gastric acidity, gastric emptying, and gastric absorption.
B Incorrect: Younger children have thinner skin and disproportionate skin surface area, resulting in variations in absorption.
C Correct: The intravenous route demonstrates the least variability, because regardless of the age the drug is injected directly into circulation. 
D Incorrect: Because of the variation of sites used in different ages, the IM route has more variability in absorption than IV.

PTS: 1 REF: p. 113 OBJ: Cognitive Level: Comprehension

21.In preparation for administering an injection to a child at the dorsogluteal site, the nurse positions the child:

a. on the abdomen with the toes pointing inward.
b. on the abdomen with the toes pointing outward.
c. supine with the toes pointing inward.
d. supine with the toes pointing outward.

ANS: A

Feedback
A Correct: This position promotes relaxation of the muscles in the buttocks.
B Incorrect: With the toes pointing outward, there is less relaxation of gluteal muscles.
C Incorrect: The dorsogluteal site is on the dorsal, not ventral side of the body.
D Incorrect: The dorsogluteal site is on the dorsal, not ventral side of the body.

PTS: 1 REF: p. 121 OBJ: Cognitive Level: Application

22.The nurse understands that the method of choice for administration of parenteral analgesics to children is:

a. IV push. c. via a soluset.
b. intramuscular. d. via a syringe pump.

ANS: A

Feedback
A Correct: IV bolus is the method of choice for administering parenteral analgesia, because it provides rapid response by administering it into the port closest to the child.
B Incorrect: The IM route can be painful and has a slower response than IV bolus.
C Incorrect: This IV method provides a slower response, because the medication flows away from the child.
D Incorrect: This IV method provides a slower response than IV bolus, because the medication must travel from the pump to the child.

PTS: 1 REF: p. 122 OBJ: Cognitive Level: Comprehension

23.When asked about the use of herbal therapy for children, the nurse appropriately replies:

a. “Adverse effects are seen less commonly in children.”
b. “Parents should not assume that ‘natural’ means ‘safe.’”
c. “The use of herbal therapy for children has declined recently.”
d. “Extensive studies have documented toxic effects of herbs and plants in children.”

ANS: B

Feedback
A Incorrect: This is a false statement.
B Correct: Unfortunately, “safety” of “natural” is a prevailing public perception about herbals in general.
C Incorrect: The use of herbals by children and their parents have increased over recent years.
D Incorrect: Little research has been done on the effects of herbals in children.

PTS: 1 REF: p. 122 OBJ: Cognitive Level: Application

24.An unconscious child is brought to the ED as a victim of an accidental poisoning. The nurse will plan to:

a. administer syrup of Ipecac and provide for oral suctioning.
b. administer activated charcoal via a nasogastric or orogastric tube.
c. prepare the child for surgery to insert a gastric tube.
d. provide the child with large amounts of oral fluids.

ANS: B

Feedback
A Incorrect: Syrup of Ipecac is not longer endorsed by poison control centers or the AAP (American Academy of Pediatrics).
B Correct: Research has shown that activated charcoal or magnesium sulfate are effective in preventing gastric absorption of poisons. It would need to be administered via an N/G or orogastric tube, because the child is unconscious.
C Incorrect: There is not indication in the scenario that the child needs a surgically placed G-tube.
D Incorrect: Oral fluids are inappropriate, because the child is unconscious.

PTS: 1 REF: p. 125 OBJ: Cognitive Level: Application

25.The nurse prepares to administer an intramuscular injection to a child. The first action is to:

a. allow the child to choose what time the youngster will get the injection.
b. prepare to administer the injection in the subcutaneous tissue.
c. ask to parents to stay in the room with the child during the injection.
d. apply a topical local anesthetic (EMLA, etc) to the site 1-2 hours prior to injection.

ANS: D

Feedback
A Incorrect: This is not a choice for the child to make.
B Incorrect: This is an intramuscular injection.
C Incorrect: Parents should have a choice as to whether they stay in the room during any procedure.
D Correct: A topical local anesthetic to the injection site 1-2 hours prior to the injection will provide for pain management during the injection.

PTS:1REF:p. 120, Safe Nursing Practice 5-3

OBJ: Cognitive Level: Application

26.The best way for the nurse to evaluate the parent’s ability to administer medications is:

a. have more than one nurse explain the procedures at different times during the child’s hospitalization.
b. have the parents verbally explain medication administration to their child and document that the parents demonstrated verbal understanding.
c. provide the parents with a demonstration of medication administration, both during hospitalization and prior to discharge.
d. have the parents demonstrate the procedures to the nurse after the nurse has explained and demonstrated the procedures.

ANS: D

Feedback
A Incorrect: This is teaching, but will not provide appropriate evaluation data.
B Incorrect: Although this provides verbal evaluation, it is not the best method.
C Incorrect: This provides the instruction, but does not provide evaluation.
D Correct: Return demonstration by the parents is the best method for evaluating their ability to administer medications to their child.

PTS: 1 REF: p. 126 OBJ: Cognitive Level: Evaluation

27.The scalp vein site for IV fluid administration is most appropriate for:

a. a young preschooler. c. a school-age child.
b. a newborn or young infant. d. an adolescent.

ANS: B

Feedback
A Incorrect: Superficial veins in the hand are best for the preschooler.
B Correct: Scalp veins are best for newborns and young infants.
C Incorrect: The veins in the hands or arms are the best sites for school-age children.
D Incorrect: The veins in the hands or arms are the best sites for adolescents.

PTS: 1 REF: p. 124 OBJ: Cognitive Level: Comprehension

28.The nurse is preparing to start an IV on a child anticipating at least four days of IV therapy. The nurse would likely choose for the infusion:

a. a butterfly needle. c. a central venous access.
b. a catheter. d. an intra-arterial catheter.

ANS: B

Feedback
A Incorrect: Butterfly needles are more appropriate for use in hours rather than days of IV therapy.
B Correct: Catheters are preferred for days of IV therapy.
C Incorrect: There is not indication for a health care provider to insert a central venous catheter. The insertion is beyond the scope of practice for a nurse.
D Incorrect: The fluids are to be administered intravenously, not intra-arterially.

PTS: 1 REF: p. 122 OBJ: Cognitive Level: Application

29.A child is prescribed to receive an IV antibiotic that is packaged in 100 mL of IV fluids to infuse in one hour. The nurse programs the volumetric infusion pump for what rate?

a. 25 mL/hr c. 50 mL/hr
b. 100 gtt/min d. 100 mL/hr

ANS: D

Feedback
A Incorrect: This rate will require four hours for the medication to infuse.
B Incorrect: A pump is programmed based on mL/hr.
C Incorrect: This rate will require two hours for the medication to infuse.
D Correct: If 100 mL are to infuse over an hour, the rate would be 100 mL/hr.

PTS: 1 REF: p. 108 OBJ: Cognitive Level: Application

30.A child who weighs 44 pounds is prescribed an IV medication with a recommended dosage of 7.5 mg/kg/24 hours in three divided doses. What is the safe individual dose this child can receive?

a. 20 mg c. 40 mg
b. 50 mg d. 100 mg

ANS: B

Feedback
A Incorrect: This is too small a dose.
B Correct: Divide 44 pounds by 2.2 = 20 kg X 7.5 mg = 150 mg, divided by 3 doses = 50 mg/dose
C Incorrect: This is too small a dose.
D Incorrect: This is twice the safe dose.

PTS:1REF:p. 103 | p. 115

OBJ: Cognitive Level: Application

31.When preparing medication, the nurse observes the seven rights, including the right client by:

a. accurately measuring the dose.
b. confirming how the drug is to be administered.
c. checking the identification band.
d. documenting the administration of the medication.

ANS: C

Feedback
A Incorrect: This refers to the right dose.
B Incorrect: This refers to the right route.
C Correct: Always check the identification band on the client to ensure it is the right client
D Incorrect: This refers to the right documentation, but is not performed until after the medication is administered.

PTS:1REF:p. 46 | p. 115

OBJ: Cognitive Level: Application

MULTIPLE RESPONSE

1.When obtaining baseline data on a child, it is important for the nurse to:

a. secure the child’s medication history from a caregiver.
b. ask the child about how the youngster interacts with other children.
c. determine the experience the child has had with taking medications.
d. obtain a personal and family history of allergy.

ANS: A, C, D

Feedback
Correct a, c, and d are important sources of baseline data.
Incorrect b does not impact on the child’s medication experience.

PTS:1REF:p. 115, Safe Nursing Practice 5-1

OBJ: Cognitive Level: Application

2.The nurse is preparing an IV setup for a pediatric client and decides to use a volumetric infusion pump. The decision is based on knowledge of these pumps and their ability to:

a. decrease nursing assessment and monitoring time
b. maintain constant intravascular pressure within the IV access
c. maintain the patency of the vascular access
d. provide accurate flow rates

ANS: B, C, D

Feedback
Correct b, c, and d are correct.
Incorrect a. The nurse must assess and monitor IVs being maintained by volumetric IV pumps, just as with gravity drip administration

PTS: 1 REF: p. 87 OBJ: Cognitive Level: Comprehension

3.When preparing to initiate a venipuncture for IV fluid and medication administration, the nurse considers which of the following?

a. Select a site that does not severely limit the child’s activity.
b. Select a site on the nondominant side.
c. Select the smallest gauge possible that will allow for the prescribed IV fluids.
d. Select the site that is the quickest and easiest for the nurse to access.

ANS: A, B, C

Feedback
Correct a, b, and c are correct considerations for the nurse.
Incorrect d is not an appropriate consideration for the nurse.

PTS: 1 REF: p. 122 OBJ: Cognitive Level: Application

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